CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Alton Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $140
Cash Discount Price: $112
vs. Medicare Baseline: 4.32x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Alton Memorial Hospital is $140. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.32x the Medicare baseline. Located in One Memorial Drive, Alton, IL.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$140

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $112 (346%)

Insurance Median: $140 (432%)

Cash: $112 (346% of Medicare)

Ins. Median: $140 (432% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 432% of the Medicare baseline (a markup of 332%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$31 - $332	96%
Blue Cross Blue Shield	$31 - $216	96%
Essence Healthcare [221]	$31	96%
Humana	$31 - $103	96%
UnitedHealthcare	$31 - $138	96%
Cox Health [757]	$32	99%
Devoted Health Plan [847]	$32	99%
Medica [662]	$32	99%
Healthlink [225]	$90 - $140	278%
Cox Health Systems Insurance Company [220]	$102 - $121	315%
Health Alliance [224]	$102	315%
Allied Benefits [498]	$108 - $332	333%
Hope Trust [806]	$108	333%
Med-Pay [480]	$121 - $140	373%
Unicare [568]	$121 - $140	373%
Healthscope Benefits [258]	$127	392%
First Health Commercial [734]	$138	426%
Beechstreet [551]	$140	432%
Detego Health [868]	$140	432%
Health Systems Inc [620]	$140	432%
Healthcare Sol Mercy [609]	$140	432%
Multiplan Commercial [737]	$140	432%
Multiplan [240]	$140	432%
Phcs [244]	$140 - $149	432%
Preferred Health Professionals [561]	$140	432%
Cigna	$149 - $328	460%
Hfn [563]	$149	460%
Medica [661]	$149	460%
Consociate [478]	$237	731%
Sarah Bush Lincoln [636]	$237	731%
Apwu Health Plan [216]	$328	1012%
Nalc Health Benefit Plan [242]	$328	1012%
Priority Health [648]	$328	1012%
Coresource [497]	$332	1025%
Fmh Benefit Service Inc [222]	$332	1025%
Mail Handlers [495]	$332	1025%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $112.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Alton Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.